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| "english_text": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.", |
| "translated_text": "一名20岁女性自8岁起因特发性肾病综合征（NS）随访，起病为脑静脉血栓形成并延伸至右颈静脉，合并大面积肺栓塞。患者未遗留任何后遗症。无其他内科或外科既往史。无血栓家族史。初诊时患者无肾功能衰竭、无肉眼血尿或高血压；此外，无提示继发性肾病综合征的肾外表现，故未行肾活检。据此给予抗凝治疗（口服维生素K拮抗剂）及口服糖皮质激素治疗，病情进展良好。随后因NS激素依赖性复发多次接受大剂量糖皮质激素治疗。此后予以吗替麦考酚酯（MMF）作为基础治疗，以避免糖皮质激素并确保正常生长。行全面的血栓前状态评估未见异常。同型半胱氨酸、血纤维蛋白原、蛋白C、蛋白S、抗凝血酶III、凝血因子V Leiden突变、JAK-2突变、冷球蛋白、抗心磷脂抗体、狼疮抗凝物以及β1-糖蛋白抗体均正常。抗凝治疗于9年后停止。此后病程中发生多次复发，均经口服糖皮质激素控制。自2017年起NS进入缓解，2019年逐渐停用MMF，患者保持无症状且未再复发。\n\n一年后，患者因急性剧烈弥漫性腹痛（无明显放射）伴餐后呕吐及双下肢水肿6小时来我院急诊就诊。体格检查示上腹部明显压痛，生命体征正常（血压120/70 mmHg，心率83次/分，室内空气血氧饱和度100%）。无发热，意识清楚。其余体格检查无特殊。尿试纸检查提示蛋白尿。血气分析示代谢性酸中毒伴呼吸性代偿。进一步实验室检查示低白蛋白血症、高胆固醇血症、凝血酶原时间为90%、D-二聚体、乳酸脱氢酶及肌酸磷酸激酶升高，并有炎症反应：CRP 37 mg/L，白细胞增多为26.4 x 10^3/µL。肝肾功能正常。\n\n患者收入重症监护病房，严密监测生命体征并启动复苏措施。紧急腹部超声提示腹腔内少至中等量积液。腹部CT显示上肠系膜动脉急性血栓形成并急性肠系膜缺血。患者即刻转入手术室。术中探查证实肠系膜缺血，几乎全小肠广泛坏死，其切除与生命不相容，见图3。患者于48小时后死亡。" |
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| "english_text": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n", |
| "translated_text": "我们报告一例34岁女性，孕8周，既往无其他值得关注的个人病史，因全身性惊厥，发作后期伴构音障碍就诊急诊，症状在不足两小时内逐渐缓解。查体：神志清楚，定向力正常，无语言、运动或感觉障碍。仅见右侧舌侧缘咬伤体征。\n\n血液检查、心电图等辅助检查均正常。鉴于此次发作为首发癫痫发作且患者处于妊娠期，申请紧急颅脑磁共振检查。\n\n按常规流程完成检查，获得轴位、冠状位及矢状位的三维T1序列（静脉注射对比剂前后）、轴位FLAIR、轴位T2、VEN BOLD及磁敏感序列，以及轴位弥散加权成像和表观弥散系数图。MRI显示多条皮质—髓质静脉血管结构向心性汇聚至一条较大的中央静脉结构，经下交通静脉引流入左侧横窦，形成典型的“美杜莎头”征。在T1序列上，可见引流静脉信号增高，增强后中央低强化，提示部分血栓形成或血流缓慢。此外，在T2及FLAIR序列上，引流静脉周围脑实质呈高信号，未见弥散受限，符合水肿。\n\n上述发现提示发育性静脉异常，伴周围部分性血栓形成及近端更为缓慢的血流征象，导致周围组织水肿。予以克赛 60 mg/12小时及左乙拉西坦 500 mg/12小时治疗，一周后患者改善并症状稳定。" |
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| "english_text": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.", |
| "translated_text": "一名22岁女性就诊于口腔内科，主诉口腔溃疡致疼痛及进食饮水困难，已持续1个月。该情况起病以发热为先，唇部出现类似粉刺样丘疹。根据病史采集，发现其使用烟弹式电子烟约1年，但此前从未出现此次就诊时的类似不适。在开始使用电子烟之前，她从未吸过传统香烟。其表示尝试电子烟的原因出于好奇，并且相当频繁地尝试不同类型、不同口味的烟油。在出现本次不适之前，她只是将烟油更换为另一种口味，未提及品牌。她几乎每天都抽电子烟，但并非整天，仅在空闲时或与朋友在一起时使用。她为健康个体，在本次情况出现前无用药史，包括抗生素、镇痛药、抗癫痫药、非甾体抗炎药及抗真菌药。亦无药物或食物过敏史，但患者饮食习惯不健康（进食不规律，且不食用蔬菜和水果）。口外检查显示身体其他部位无病变；患者唇部可见浆液血性痂皮及口角处糜烂区，且有出血倾向。口内检查见白色溃疡，边缘呈淡黄色，不规则、大小不一，伴有疼痛，位于唇黏膜、颊黏膜、舌侧缘及腹面黏膜和口底。\n\n根据患者病史和体格检查（显示累及口腔黏膜而全身其他部位无症状），结合抗HSV-1 IgG为非反应性，确立诊断为与电子烟相关的口腔多形红斑。该病情被归类为轻型多形红斑。口腔病变采用0.9%氯化钠溶液治疗，用纱布浸湿后置于唇部，每日3次。嘱患者以1 mg地塞米松加入10 mL透明质酸后含漱，每日3次，含漱后至少30分钟内避免进食或饮水。另给予右侧口角创面外用2%咪康唑乳膏，每日2次，并给予白凡士林软膏用于干燥的唇部。为维持良好的口腔卫生，建议其于早餐后及睡前每天两次刷牙并清洁舌头。并嘱其停止使用电子烟，避免摄入含谷氨酸钠（味精）的食物。治疗后一周进行复诊，显示口腔情况已有改善。已获得患者关于细节发表的书面知情同意。本病例报告符合《赫尔辛基宣言》。本病例报告的发表亦已获得所在机构批准。" |
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| "english_text": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.", |
| "translated_text": "一名29岁，孕5产4（均存活，3次为自然阴道分娩，最近一次因引产失败于现孕前4年行剖宫产）的孕妇，按末次正常月经推算孕周32周来进行产前检查随访。\n\n经病史采集得知，其四个孩子均健康、在校表现良好，无已知遗传或癫痫性疾病史。行梅毒血清学试验（VDRL）、乙肝表面抗原（HBsAg）及尿常规检查，结果均为阴性。全血细胞计数（CBC）各细胞系正常；血型为A型，Rh阳性。行产科超声检查，提示除心脏外，胎儿全身各部位解剖扫查均正常。进一步行胎儿超声心动图评估，结果如下：双心房大小相当，位置关系正常（situs正常）。房室瓣及半月瓣位置正常，启闭良好。双心室大小与收缩性相当；二维和彩色血流显示左心室构成心尖，未见室间隔缺损。但在左心室乳头肌可见两个边界清楚、圆形、高回声肿块，大小分别为18.2 mm×8.3 mm和13.5 mm×8.3 mm。评估流出道时，二维及彩色血流（CF）超声显示左室流出道（LVOT）及右室流出道（RVOT）解剖与功能均正常。根据胎儿超声心动图所见，诊断为心脏横纹肌瘤。鉴于心脏横纹肌瘤提示合并结节性硬化症的概率较高，遂行详细神经超声及其他系统检查以查找结节性硬化症的其他体征。尽管进行了针对结节性硬化症其他特征的检查，除该肿瘤外未发现其他体征。自孕32周至39周期间规律产前随访，未见并发症。\n\n孕39周+1天，因足月妊娠并要求再次剖宫产而行剖宫产术，娩出女婴一名，体重3200 g，出生后第1分钟与第5分钟阿普加评分均为10分。母婴术后经过顺利，于术后第3天出院。\n\n分娩后分别于生后第1、7、30天评估肿块有无缩小或增大、是否出现皮肤损害或癫痫发作。体格检查均正常，肿块大小与产前评估相似。\n\n在其7个月时再次评估，病史询问显示该婴儿发育情况良好，符合其年龄组。对其神经发育迟缓进行了检查，儿童生长发育与年龄相称。由小儿心脏科医师行超声心动图检查，示左心室双侧乳头肌各有边界清楚的高回声肿块，大小分别为21.8 mm×9.2 mm和14.7 mm×8.5 mm，未造成左室流入道梗阻。\n\n在其第一年评估期间，获取了家族病史，并进行体格检查及人体测量，以评估其发育状况。该儿童发育正常，与同龄儿童一致。除心脏外，所查各系统未见异常。超声心动图显示左心室双侧乳头肌上均有边界清楚的高回声肿块，较前未见增大，且未造成左室流入道梗阻。" |
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| "english_text": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n", |
| "translated_text": "来自库斯科的13岁男孩，自2岁起患喉乳头状瘤病（3岁时需行气管造口术），其母有生殖器乳头状瘤病史。患者在为期16天的病程后入院至利马的圣博尔哈国家儿童健康研究所，病程以夜间为主的呼吸困难、吸气性喉鸣及中度发声障碍为特征；此前给予阿奇霉素和氧疗支持，未见好转。\n\n体格检查示轻度肋下回缩，左侧半胸肺泡呼吸音减弱，右侧半胸以少量哮鸣音为主，需以双鼻导管给予4升氧气支持。其余评估无相关发现。实验室方面，白细胞8.03 × 103/u，血小板209 × 103/u，血红蛋白13.2 g/dL，C-反应蛋白36.6 mg/L。影像学检查包括胸部X线片及头颈部断层扫描。\n\n入院48小时后，她出现喉鸣加重和呼吸困难，遂决定收入急诊手术室行气管造口术、显微手术及乳头状瘤病病灶切除术。可见呈乳头状外观的带蒂肿瘤，累及会厌、声门面、室带、声带、声门下及气管至第5环。病理报告提示由于HPV导致的空泡细胞样异型性及轻度局灶性不典型增生。\n\n术后即刻转入小儿重症监护病房行呼吸监测，并于48小时撤离氧疗。予贝伐珠单抗400 mg静脉单次给药，随后临床好转。患者住院7天，通过血氧饱和度水平的正常化及逐步撤离氧疗达到临床稳定，随后转至布雷尼亚的医院继续管理。8个月后进行远程监测，家属表示无复发或其他并发情况的证据。" |
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| "english_text": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.", |
| "translated_text": "一名54岁男性，既往有膜性肾病II期合并肾病综合征病史，长期口服糖皮质激素及免疫抑制剂治疗。患者有20包年吸烟史，否认遗传性疾病家族史。入院前1个月胸部X线片示正常。2016年8月8日，因发热伴进行性呼吸困难、咳嗽、咳痰5天入院。入院时，患者BMI为24.5 kg/m2，体温39.0°C。此外，患者存在呼吸急促（35次/分）和严重低氧血症（SaO2 86%）。听诊示双侧气体进入良好，可闻及散在弥漫性湿啰音及干啰音。此外，胸部CT显示多发磨玻璃样影，实验室检查白细胞（WBC）计数正常，但中性粒细胞计数、C反应蛋白（CRP）、红细胞沉降率（ESR）及（1→3）-β-D-葡聚糖升高。住院第4天检测到RSV-Ab阳性时，诊断为RSV感染。\n\n入院后立即给予呼吸监测及吸氧以改善低氧饱和度，并予抗生素（莫西沙星4天，随后头孢米诺8天）及抗真菌治疗（伏立康唑10天）。糖皮质激素及免疫抑制剂剂量基本不变。治疗10天后，患者病情加重。胸部CT提示病情进展，氧分压进一步下降。患者转入急诊重症监护病房，予强化治疗，包括无创机械通气，广谱抗生素（静脉美罗培南、口服莫西沙星及复方磺胺甲噁唑）、抗真菌治疗（米卡芬净）、糖皮质激素（甲泼尼龙40 mg bid静脉注射）以缓解炎症，以及其他支持治疗。由于可能存在病毒感染（如巨细胞病毒），同时给予更昔洛韦。5天后，根据胸部X线片评估，患者病情进一步加重。尽管再次给予治疗，包括有创呼吸机辅助通气治疗、甲泼尼龙（80 mg bid）、抗菌药物（头孢哌酮/舒巴坦、替加环素及复方磺胺甲噁唑）及抗真菌（米卡芬净）治疗，患者最终于2天后死亡。" |
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| "english_text": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n", |
| "translated_text": "34岁患者，病程4周。两个月前，于妊娠第37周行剖宫产术，术后切口持续出血。否认儿童期或青春期出血史。三年前，她分娩第一胎（亦为剖宫产），因染色体异常而死亡（据患者自述）。另述对曲马多过敏。\n\n临床表现起始为因双侧肾结石导致的腰痛。随后患者排出一枚结石，此后出现血尿3天，予氨甲环酸每12小时一次。三周后，出现左大腿下部疼痛，逐渐加重，局部变硬。因症状持续，予肌内注射双氯芬酸，导致臀部出现瘀斑及出血，即便纱布加压仍持续。\n\n患者在私人机构行多普勒超声提示左下肢深静脉血栓形成，遂携带结果至当地医院就诊。予依诺肝素30 mg/24 h皮下注射抗凝，并给予吗啡镇痛后住院。次日出现上腹痛、视物模糊，心率117次/分，血压113/85 mmHg，血氧饱和度93%。遂决定停用依诺肝素。血常规示血红蛋白6.4 g/dl，较入院前一日的10.4 g/dl下降4 g/dl。为此给予输血2次。因怀疑血管炎，予甲泼尼龙，并转至我院进一步检查。\n\n入院查体见重度苍白，左大腿及膝外侧大片瘀斑，右大腿可见血肿。血常规提示中度贫血（Hb = 9.8 g/dl），正细胞、正色素。生化检查示葡萄糖160 mg/dl。肝酶AST、ALT分别为52 U/L和86 U/L。凝血功能显示活化部分凝血活酶时间（APTT）延长至91.2 s。其余血常规、生化、电解质、肝功能及凝血指标正常。右侧臀部软组织超声示皮下蜂窝组织（TCSC）层液性集合，并可见水肿延至大腿上1/3。左下肢多普勒超声示血流量评估良好，股总静脉及浅、深静脉未见血栓征象。\n\n予对症治疗，并送血、尿培养，结果均为阴性。抗核抗体（ANA）、补体C3、C4及铁蛋白均在参考范围内。\n\n鉴于疑诊获得性血友病，申请相关检查以确认，其中混合试验显示aPTT部分矫正。测定第VIII因子，活性降低（<1.0 U/dl），并证实存在第VIII因子抑制物：8.64 Bethesda单位/ml。以上结果证实获得性血友病的诊断，结合症状起始时间，考虑与产后期相关。\n\n开始予泼尼松50 mg早餐时口服、10 mg午餐时口服，环磷酰胺50 mg片2片每24小时口服一次，以及用于血友病的第VIII因子抑制物旁路活性复合物（FEIBA）。5天后因胸闷、呼吸困难和恶心（可能为药物不良反应）停用FEIBA，改用重组活化第VII因子（NovoSeven）。\n\n患者临床转归良好，瘀斑减轻，无其他症状，遂出院。" |
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| "english_text": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.", |
| "translated_text": "我们在此报告一例出生两天、出生即有右侧阴囊肿胀而入院于儿童医院的新生儿病例。患儿在私立医院足月经剖宫产出生。在新生儿室留观1天。检查的医生将其转诊以行紧急外科处理，但他们花了一天才到达我院。入急诊时，患儿水合良好，在室温下皮肤呈粉红色，灌注良好。查体示右侧睾丸肿大、紧张、无压痛，肉眼可见发红，表面皮肤擦脱。透光试验右侧阴性，对侧睾丸阳性。双侧疝环正常。已完成所有实验室检查，并紧急行腹股沟阴囊区多普勒超声检查。超声发现右侧睾丸增大（15.6*9.4 mm），呈异质性低回声，睾丸网显著，彩色多普勒分析未见血流信号。左侧睾丸大小、形态及回声结构正常，伴少量鞘膜积液。紧急行阴囊探查术。术中见右侧睾丸明显坏死，存在鞘膜内睾丸扭转，伴少量鞘膜积液。随后行右侧睾丸切除术及对侧睾丸固定术。" |
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| "english_text": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n", |
| "translated_text": "4岁男性患儿，入院前两周有鼻部脓疱病史（外用莫匹罗星及口服头孢羟氨苄治疗；剂量、疗程及依从性不详），无其他病史，出现肉眼性肾小球性血尿，伴下肢水肿，病程5天，就诊前12小时出现头痛、恶心和呕吐。经历20分钟全身强直-阵挛性发作后，以癫痫持续状态至急诊科（ED）就诊。\n\n入ED时无发热，血压无法评估，意识水平受损，伴全身肌张力增高及双下肢和胫前水肿。决定行气管插管，并给予苯巴比妥（10 mg/kg）控制癫痫持续状态。\n\n入重症监护病房（ICU）体检：血压134/94 mmHg（BP 110 mmHg）（该患儿p95为108/66 mmHg，p95+12为120/78 mmHg）。\n\n初始实验室检查：尿常规示血尿（每视野>100个红细胞）、蛋白尿3+、白细胞尿10–25/视野，血肌酐0.3 mg/dL；贫血，红细胞比容（HTO）21%，血红蛋白（Hb）7 g/dL；平均红细胞体积（VCM）及平均红细胞血红蛋白浓度（CHCM）正常；白细胞增多23,900 个/mm3，血小板增多756,000/mm3；急性期反应物未升高；低补体血症，补体C3为25 mg/dL（正常值，VN：80–150 mg/dL），C4正常。咽部A组β溶血性链球菌（化脓性链球菌）快速抗原检测阳性，抗链球菌溶血素O（ASO）阳性。头颅CT平扫未见急性改变。肾脏超声提示双肾增大，皮质回声增强，皮髓质分界减弱。\n\n诊断为由于复杂性GNAPE所致的肾炎综合征，伴高血压急症 - 癫痫持续状态。\n\nICU入住前24小时内，患儿需机械通气（MV）及苯巴比妥抗惊厥治疗。此后无再发作，脑电图（EEG）（入院次日）正常，脑脊液检查正常。为根除化脓性链球菌予以头孢噻肟抗生素治疗，并给予呋塞米利尿治疗。\n\n次日出现肾功能损害，血肌酐升至0.99 mg/dL，高血压及24小时蛋白尿36.6 mg/m2/h，无少尿。开始氨氯地平及静脉拉贝洛尔降压治疗，初步控制良好。\n\n病情好转后于48小时拔管，通气耐受良好。然而，拔管后24小时患儿意识恶化，仅对疼痛刺激有睁眼及肢体回撤，言语反应差（格拉斯哥昏迷评分8分），并出现血压数值> p95+12，尽管接受持续输注拉贝洛尔（最高至3 mg/kg/h）、氨氯地平（10 mg/d）及呋塞米治疗，仍需重新行机械通气，并静脉泵注硝普钠（最高至3 μg/kg/min），旨在逐步降低血压（每日25%），以预防继发性神经系统损害。鉴于肾小球肾炎患儿出现与高血压（HTA）相关的急性神经系统症状，考虑PRES诊断，并于第5天行头颅磁共振成像（MRI）证实：枕叶双侧对称皮质下信号增高，弥散未受限，与血管源性水肿相符（PRES）。眼科评估正常，复查脑电图提示偶发全导联电压降低发作。\n\n治疗中加用依那普利。最终，经过10天缓慢药物减撤，血压正常化。复查MRI（第12天）显示前述改变消退。5天后成功拔管。\n\nICU期间，血红蛋白降至5 g/dL，平均红细胞体积和平均红细胞血红蛋白浓度正常，无血小板减少，因直接抗人球蛋白试验阳性及血红蛋白尿，考虑溶血性贫血。需要红细胞输注2次。给予甲泼尼龙（1 mg/kg/d）激素治疗，共72小时。粪培养阴性，肺炎链球菌尿抗原亦阴性。爱泼斯坦-巴尔病毒和B19微小病毒血清学、可提取核抗原（ENA）谱、抗中性粒细胞胞浆抗体（ANCA）、抗DNA抗体、抗β2糖蛋白1抗体、抗心磷脂抗体及狼疮抗凝物均为阴性。所有培养均为阴性（血培养、尿培养、气管插管抽吸物培养及咽部培养）。抗核抗体（ANA）1/160阳性。\n\n随着血压正常化、补体水平升高及尿检无蛋白尿或血尿，患者病情改善。住院第9天直接抗人球蛋白试验仍阳性。\n\n第31天出院时，血压正常、无贫血、肾功能保存、无蛋白尿或血尿，C3水平恢复正常，神经系统无症状。出院带药为泼尼松、氨氯地平、依那普利和叶酸。出院后6个月未复发，仍无症状。" |
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| "english_text": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.", |
| "translated_text": "一名69岁男性，既往行冠状动脉旁路移植术（CABG），因轻度活动即出现重度呼吸困难（NYHA III）已持续2个月，于本中心入院。心电图示II、III、aVF及V4-6导联ST段压低，血液检查显示血浆N末端B型利钠肽前体水平升高（2640 pg/mL）。超声心动图示左心室收缩功能不全，左心室射血分数降低（30%）。患者于2009年（59岁时）发生下壁ST段抬高型心肌梗死，冠脉造影证实重度三支病变（冠脉造影示左前降支（LAD）近段CTO，左回旋支中、远段90%狭窄，右冠状动脉中段95%狭窄）。患者于2009年行CABG：左乳内动脉（LIMA）-LAD，串联大隐静脉移植（SVG）至第一钝缘支（OM1）、第二钝缘支（OM2）及后外侧支（PL）。\n\n经左桡动脉6 French（Fr）通路行冠脉造影，显示LIMA-LAD及SVG-OM1、OM2移植物通畅，但串联至PL的SVG移植物完全闭塞。本位左主干开口部闭塞，右冠本血管中段闭塞，可见桥接侧支。我们决定治疗右冠本血管CTO。于右股动脉置入另一6 Fr鞘建立双动脉通路。左、右冠分别以6 Fr AL 0.75（Launcher; Medtronic; USA）和6 Fr EBU 3.5（Launcher; Medtronic; USA）导引导管插管。尝试经左桡动脉顺行途径；然而，无论是Fielder XTR导丝（Asahi Intec, Japan）还是配合Finecross微导管（Terumo, Japan）的Gaia 3导丝（Asahi Intec, Japan）均未能进入右冠远段真腔。随后在Crusade微导管（Kaneka, Japan）辅助下采用平行导丝技术，使用两根Gaia 3导丝（Asahi Intec, Japan），亦未成功。因而改用经室间隔通道的逆行途径，自LAD经闭塞的左冠状动脉系统进入。Gaia 3导丝（Asahi Intec, Japan）跨越闭塞的左主干（LM）及LAD，最终进入LAD远段真腔。通过Finecross微导管（Terumo, Japan）在LAD远段置换为Sion导丝，并用2.0 × 15 mm球囊扩张LM及LAD近段。随后采用室间隔“冲浪”技术（SST）通过室间隔通道。我们尝试自LAD近段至远段起源的不同室间隔通道，在150 cm Finecross微导管（Terumo, Japan）支持下，将Sion导丝（Asahi Intec, Japan）经远端室间隔支逆行送入右冠远段。Gaia 3导丝（Asahi Intec, Japan）逆行跨越CTO病变进入右冠近段真腔，并进入置于顺行导引导管内的Guidezilla导引延长导管（Boston Scientific, USA）。将Finecross微导管（Terumo, Japan）送至顺行导管，随后外置RG3导丝（Asahi Intec, Japan）。随后用2.0 × 15 mm球囊预扩张CTO病变，并植入2枚重叠的药物洗脱支架（2.5 × 38 mm和3.0 × 38 mm），造影结果极佳，所有远端分支TIMI 3级血流。\n\n出院时呼吸困难缓解。6个月随访，患者无呼吸困难复发。" |
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| "english_text": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.", |
| "translated_text": "一名51岁男性患者因左眼（LE）急性疼痛性视力下降3天来就诊。最佳矫正远视力（BCDVA）分别为右眼（RE）20/20、左眼手动（HM）。双眼眼球运动正常。双眼前节检查未见异常。左眼眼底检查示ONH肿胀、脉络膜隆起、多发视网膜下液体积聚斑片及视网膜色素上皮（RPE）皱褶。右眼眼底检查未见异常。\n\n我们采用多模态成像，包括光学相干断层扫描（OCT）（OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18）、眼底蓝光自发荧光（BAF）、荧光素血管造影（FA）（Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0；Heidelberg Engineering）、吲哚菁绿血管造影（ICGA）和B型超声检查进行进一步评估。此外，还开具了眶部和脑部MRI并行钆增强检查。OCT图像显示RPE及脉络膜轻度隆起，RPE高反射并伴后方阴影，视网膜下及视网膜内液体积聚，以及轻度视网膜增厚。左眼ICGA图像可见黄斑部地理样低荧区。BAF显示黄斑部存在一处地理样斑驳自发荧光模式的区域。B型超声发现视神经增大。FA图像中，可见ONH处血管渗漏明显（热视盘）。此外，发现一处大小为三个视盘直径（DD）的地理样斑片状低荧区，边缘呈斑点状高荧光。眶部及脑部MRI显示在视神经与巩膜交界处可见后球部结节样肿块，钆增强。肿瘤科会诊未见明显异常。\n\n鉴于存在恶性肿瘤的可疑以及眶内强化结节样肿块，患者于就诊后一周接受经结膜外侧眶切开术。术中发现局灶性粉红色巩膜结节，并见Tenon囊水肿。以结节性后巩膜炎为临床诊断行Tenon囊下注射醋酸曲安奈德。患者拒绝住院及静脉注射糖皮质激素治疗。开始口服泼尼松龙 50 mg/Kg。风湿免疫科会诊及筛查实验室结果，包括PPD试验（结核）、胸部X线片、血清ACE水平（结节病）和C-ANCA水平（韦格纳肉芽肿），均未见异常。最后一次随访检查（术后1周）时，患者的BCDVA分别为RE 20/20、LE 2米数指。此外，SRF被吸收，黄斑出现萎缩。口服泼尼松龙缓慢减量，持续三个月。" |
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| "english_text": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.", |
| "translated_text": "一名来自埃塞俄比亚阿姆哈拉地区的78岁老年患者，既往植入永久性心脏起搏器7年，因良性前列腺增生（BPH）拟行耻骨后前列腺切除术。该情况在3个月前既往行经尿道前列腺切除术之后出现。在术前麻醉评估中对患者进行了全面评估，并完成了拟行手术所需的所有常规检查，结果均在正常范围。患者近2个月来表现为尿频、尿急、夜尿及尿滴沥病史。此外，患者已知有16年高血压病史，口服氨氯地平5 mg每日一次，依那普利10 mg每日两次（BID），及阿托伐他汀10 mg每日一次。另有25年2型糖尿病病史，服用二甲双胍500 mg每日两次（BID）及中性鱼精蛋白胰岛素（NPH）20 IU和10 IU。患者入院进一步评估，心电图（ECG）提示完全性束支传导阻滞（BBB）。心脏电生理检查诊断为继发于高血压性心脏病的左心室肥厚、轻度舒张功能不全，射血分数62%。腹部超声提示前列腺增大，体积82 ml；前后位（AP）胸片示胸部正常，左侧起搏器在位，其余血液指标，包括电解质和血清肌钙蛋白水平均在正常范围。\n\n术前作为多学科处理及心脏风险评估的风险判定工具，心脏科医师参与评估。患者虚弱评分为5.5，功能性心肺储备差，代谢当量（MET）=3.4，修订心脏风险指数（RCRI）III级，提示术后30天内主要心脏不良事件（心肌梗死[MI]、心脏骤停或死亡）风险为10.1%，且基于手术类型和患者危险因素评估为中等风险。就未重新程控起搏器及麻醉和手术期间相关并发症进行了术前评估与风险告知后，患者因无法负担起搏器重新程控所需的医疗保障费用而未进行程控调整。其原因包括心脏外科手术需在埃塞俄比亚亚的斯亚贝巴进行，心外科医师寥寥无几而候诊名单漫长，且距离患者所在机构较远，并且起搏器重新程控后需有一段时间监测以应对程控后并发症。最终，患者选择继续手术，并接受相关潜在风险与伤害。强烈倡导术中持续心脏监测。尽管存在上述因素，患者未出现心肺衰竭，且一直平稳。患者直至手术当日仍继续服用氨氯地平、依那普利和阿托伐他汀，晨给予NPH较低剂量为原剂量的2/3。手术前一日午夜口服地西泮5 mg以抗焦虑。\n\n手术当日测随机血糖（RBS），并实施滑动尺度血糖控制。强调麻醉医师、外科医师及护士之间的沟通，确保电刀负极板置于远离起搏器的位置，并备妥急救药物及除颤器。术前给予地塞米松以预防恶心，并以对乙酰氨基酚进行预防性镇痛以缓解疼痛。应用美国麻醉医师学会（ASA）标准监测，并记录基线参数。于L3–L4间隙行腰硬联合麻醉，给予0.5%等比重布比卡因（12.5 mg）及芬太尼50 µg。阻滞平面达到脐部，感觉阻滞为T7。手术经脐下正中切口进行，采用低电压（20 mA）的单极电凝；止血通过低电压双极电凝完成。整个手术过程中患者生命体征保持稳定，其生命体征较基线值波动不超过10%。术中予以静脉补液复苏。术后将患者转入麻醉后恢复室（PACU）严密监测，并给予0.125%硬膜外追加镇痛10 ml。术后相关检查均在正常范围。患者在PACU观察12小时后病情平稳转回病房，并由心内科团队定期随访。术后第88天患者出院，并建议定期复查起搏器在位状态。" |
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| "english_text": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.", |
| "translated_text": "一名52岁女性因泌尿系统主诉转诊至泌尿外科门诊。其症状始于三年前，表现为尿频、尿痛及尿滴沥。她还提到尿中经常排出红色和黑色丝状物。此外，在这些排出物出现时，她伴有头痛、发热及寒战。间歇性尿道周围及生殖器瘙痒亦为其一项主诉。此前曾以反复泌尿道感染诊断由多位专科医生治疗，但无临床改善。患者否认近期旅行、露营、徒步、务农、游泳及昆虫叮咬。既往有骶尾部毛窦手术及子宫切除术史，分别于8年前和7年前行。本次就诊前两年，她因评估而住院。体格检查示外观良好，生命体征正常。包括全血细胞计数、尿液分析及生化检查在内的所有实验室检查均在正常范围。腹盆腔CT扫描未见异常。因此行膀胱镜检查，示膀胱黏膜红斑和充血，有悬浮碎屑，左侧输尿管开口扩张。与感染性疾病专科医师会诊时，怀疑血吸虫病，因此按适当剂量和疗程给予吡喹酮治疗，随后出院。\n\n然而，其症状未缓解。随后再次就诊于另一位感染性疾病专科医师，因怀疑泌尿道蝇蛆病而给予伊维菌素治疗；但仍未见好转。再次入院以聚乙二醇行膀胱灌洗，但膀胱冲洗液未见可见幼虫。该操作后出现持续两天的血尿，后自行停止。出院，并建议一个月后复查尿液分析。其随机尿液分析结果正常，遂收集24小时尿并送实验室分析，病理学家在光学显微镜下证实其中有活幼虫。将该幼虫分离并送交昆虫学家进行形态学鉴定。最终确定该幼虫属于Sarcophaga物种。建议患者注意个人卫生，并每日摄入至少3 L水。" |
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| "english_text": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n", |
| "translated_text": "现呈现一例36岁女性患者，既往有溃疡性结肠炎病史，应用柳氮磺吡啶、富马酸亚铁及间歇性泼尼松控制病情良好，遇急性加重时使用。\n\n他因进行性压迫性心前区痛1周入急诊，伴呼吸困难及植物神经症状。入院时行心电图检查示窦性心律，发现下壁ST段抬高。\n\n患者报告有6个月全身不适、乏力和夜间盗汗病史。既往出现与劳力相关的心前区疼痛，后进展至静息时发生。体格检查未闻及杂音，外周脉搏无异常。\n\n行急诊冠状动脉造影提示重度双支病变：左冠状动脉主干开口处重度病变90%，右冠状动脉开口处重度亚闭塞性病变99–100%（罪犯血管）。对右冠状动脉行初次经皮血管成形术并成功置入药物洗脱支架。介入/血流动力学医师因主动脉弓受累及球囊推进时血管脆性增高而考虑可能为主动脉炎，遂建议在对左冠状动脉主干病变行外科处理前，先进行指向炎性疾病的病因学评估。\n\n实验室检查示轻度贫血（血红蛋白：11.6 g/dL）、轻度白细胞增多（13,800/mm3）、红细胞沉降率（ESR）升高：42 mm/h，C反应蛋白（CRP）：4.9 mg/L（正常值<1），高敏肌钙蛋白升高。自身免疫相关检查显示补体C3、C4正常；抗核抗体（ANA）阴性；抗DNA阴性；可提取核抗原（ENA）谱阴性；VDRL非反应性。\n\n增强心脏磁共振（MRI）提示左心室下壁非透壁性急性心肌梗死，以及左心室前间隔-心尖部静息期心内膜下缺血。轻度主动脉及二尖瓣关闭不全。双心室收缩功能保留。\n\n胸、腹、盆腔CT血管成像（CTA）示主动脉周围纤维性壁增厚，累及主动脉根部、主动脉弓及腹主动脉，并见左冠状动脉主干重度狭窄、左锁骨下动脉及左椎动脉轻度狭窄、下肠系膜动脉重度狭窄。提示IgG4相关疾病或高安动脉炎的可能。\n\n在鉴别诊断评估中，IgG为1,600 mg/dL（参考值：700–1,600），其亚类：IgG1：1024 mg/dL（升高），其余在正常范围（IgG2：456 mg/dL；IgG3：98.8 mg/dL；IgG4：13.6 mg/dL）。\n\n结合临床与影像学诊断为高安动脉炎，开始治疗：泼尼松60 mg每日，甲氨蝶呤20 mg每周注射，叶酸1 mg每日。治疗3周后行外科心肌血运重建手术，采用左乳内动脉（LIMA）移植至前降支（DA），并行主动脉-冠状动脉旁路至回旋支。术中注意到主动脉根部及升主动脉外观良好。患者目前在家，整体状况良好，门诊随访中。" |
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| "english_text": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n", |
| "translated_text": "一名36岁女性患者主诉吞咽困难，伴长期颈部及上胸部疼痛。另有多结节性甲状腺肿，无其他重要病史。行食管胃十二指肠造影检查。吞服钡剂后可见食管近端右后外侧压迹，沿颅尾方向延伸3.5 cm。估计食管最大狭窄程度为60%。颈胸部CT扫描显示主动脉弓先天性畸形：右位主动脉弓的镜像型。主动脉弓起源于主动脉根部，经右主支气管上方走行，发出三条弓上血管如下：第一为左头臂动脉（其分出左颈总动脉和左锁骨下动脉）；第二为右颈总动脉；第三为右锁骨下动脉。随后主动脉弓自食管后方经过，并形成一个1.3 cm的小型前向囊袋，称为Kommerell憩室。该构型围绕气管-食管复合体形成一个环，其边界组成如下：右后外侧为主动脉弓，左后外侧为Kommerell憩室，左外侧为动脉韧带（或动脉索），前方为左头臂动脉。胃镜检查证实外源性压迫所致的腔内压迹。鉴于临床影响轻微且无营养障碍，最终未行手术治疗。转归良好，患者自述症状自行改善。" |
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